RT Journal
A1 Levack M, Berger D, Sylla P, Rattner D, Bordeianou L
T1 LAparoscopy decreases anastomotic leak rate in sigmoid colectomy for diverticulitis
JF Archives of Surgery
JO Archives of Surgery
YR 2011
FD February 1
VO 146
IS 2
SP 207
OP 210
DO 10.1001/archsurg.2010.325
UL http://dx.doi.org/10.1001/archsurg.2010.325
AB Background 
    Early studies comparing laparoscopic and open operations for diverticulitis failed to show any advantages of the laparoscopic approach. Our study compared the 30-day postoperative outcomes of laparoscopic and open sigmoid colectomy for diverticulitis by surgeons who had performed 20 or more laparoscopic colectomies before the study period.Hypothesis 
    Patients who undergo an electivelaparoscopic operation for diverticulitis have reduced postoperativecomplications compared with patients who have a traditional openoperation.Design 
    Retrospectiveanalysis.Setting 
    Academic medicalcenter.Patients 
    A total of 249patients who underwent elective open (n = 127) orlaparoscopic (n = 122) sigmoid colectomy with primaryanastomosis for diverticulitis between July 1, 2001, and February 1,2008.Main Outcome Measures 
    Combined rates of free and contained anastomotic leaks. A logisticregression model was used to determine predictors of anastomoticleaks while controlling for significant differences between studygroups.Results 
    Patients whounderwent laparoscopic or open operations were similar in age, sex,history of diagnosed intraabdominal abscess (9.4% vs 12.3%), andhistory of preoperative percutaneous abscess drainage (3.9% vs 4.9%).Patients who underwent the open procedure had a higher Charlsoncomorbidity index (1.6 vs 1.2; P = .04), and those wh underwentlaparoscopy more frequently underwent splenic flexure mobilization(82.8% vs 26.7%; P < .001).Patients who underwent a laparoscopy had lower rates of anastomoticleaks (2.4% vs 8.2%; P = .04).This finding held true on logistic regression analysis (odds ratio, 0.67; 95% confidence interval, 0.008-0.567; P = .01), even when controlling for age,Charlson comorbidity index, splenic flexure mobilization, and lengthof resected bowel.Conclusion 
    Anastomotic leaks occurred less frequently after laparoscopicsigmoid colectomy performed by experienced laparoscopic colorectalsurgeons.